nerve damage causing loss of taste

Saito T, Shibamori Y, Manabe Y, Yamagishi T, Yamamoto E, Ohtsubo T, et al. Lee J, Tucker RM, Tan SY, Running CA, Jones JB, Mattes RD. Recent data indicate that BMS involves both release-of-inhibition and nerve-stimulation phantoms [92], which would explain why some patients respond well to systemic GABAA therapy [93] and others to peripheral treatments (e.g., topical GABAA agonists, oral desensitization, peripheral nerve block) [94-97]. Anesthesia of the chorda tympani nerve and taste phantoms. Lim J, Wood A, Green BG. Plain radiographs have substantial limitations. Trends in antrimicrobial drug prescribing among office-based physicians in the United States. Medications are also an important, frequently overlooked cause of smell impairment (Table 2).1,6,7,15 Olfactory impairment is estimated to occur in nearly 10 percent of patients with head trauma.17 Post-traumatic smell loss is usually caused by shearing injuries to the olfactory nerve fibers at the level of the cribiform plate, but it can also be caused by direct injury to the olfactory bulbs, olfactory tracts or frontal and temporal lobes.18,19. It is important to remember the distinctive nature of these two neural systems, because some odorants (e.g., ammonia) are sensed largely by the trigeminal nerve. Handb Clin Neurol. Topical clonazepam in stomatodynia: A randomised placebo-controlled study. Removal (amputation) of a toe, foot or even part of the leg may be necessary. Bartoshuk LM, Duffy VB, Reed DR, Williams AL. Electrical taste. Computed tomographic scanning or magnetic resonance imaging of affected areas, as well as commercially available standardized tests, may be useful in selected patients. From psychophysics to the clinic: Missteps and advances. Medications can interfere with smell and taste, and should be reviewed in all patients with reported dysfunction. Phantom taste, touch, or pain sensations (e.g., burning mouth syndrome) may also occur, particularly in those expressing the most taste buds. See related patient information handout on problems with smell or taste, written by the author of this article. Spatial testing indicated complete IX loss, yet the phantom became more intense with whole-mouth topical anesthesia. Accomplishing this task has led us to reconsider the instruments used to measure sensory and affective differences, with the goal of ensuring that they render true variation rather than methodological artifacts. They include: Damage to your taste sensation nerve; . Bujas Z. Rawal S, Hoffman HJ, Bainbridge KE, Huedo-Medina TB, Duffy VB. Zuniga JR, Chen N, Phillips CL. Tomita H, Ohtuka K. Taste disturbance after tonsillectomy. Duffy VB, Bartoshuk LM, Lucchina LA, Snyder DJ, Tym A. Supertasters of PROP (6-. Measurement of feelings using visual analogue scales. Taste change following cochlear implantation. Influence of genetic taste sensitivity to 6-n-propylthiouracil (PROP), dietary restraint and disinhibition on body mass index in middle-aged women. Relationship between pediatric obesity and otitis media with effusion. This site needs JavaScript to work properly. Measuring sensation in the aged. As these varied results suggest, oral sensory damage does not preclude other factors linked to BMS, but it offers a novel mechanism for specific cases viewed previously as intractable. Patients may have difficulty recognizing smell versus taste dysfunction and frequently confuse the concepts of flavor and taste. While the most common causes of smell disturbance are nasal and sinus disease, upper respiratory infection and head trauma, frequent causes of taste disturbance include oral infections, oral appliances (e.g., dentures), dental procedures and Bell's palsy. Neurotmesis occurs in the peripheral nervous system and most often in the upper-limb (arms), accounting for 73.5% of all peripheral nerve injury cases. Miller IJ, Jr., Reedy FE., Jr. Variations in human taste bud density and taste intensity perception. Schutz HG, Cardello AV. With regard to pathology, supertasters naturally have the most oral sensation to lose, so they may encounter the most robust disinhibitory effects following nerve damage, including taste constancy and phantom sensations. Nerve damage can cause a loss of feeling in the feet, so even minor cuts can turn into sores or ulcers without being noticed. Scanning with thin cuts (5 mm) is useful in identifying bony structures in the ethmoid, cribiform plate and olfactory cleft, as well as the temporal bone in proximity to cranial nerve VII or chorda tympani nerves; however, CT scanning is less effective than magnetic resonance imaging (MRI) in defining soft tissue disease.23,29 The use of intravenous contrast media helps to better identify vascular lesions, tumors, abscess cavities and meningeal or parameningeal processes. Nevertheless, it has proven useful for assessing the specific integrity of the CT [156]. Peripheral refers to the peripheral nervous system, which consists of the vast network of nerves that connect our sense organs, muscles, glands, and internal organs to the central nervous system, which consists of the brain and spinal cord. Depending on the cause, lack of taste may resolve on its own or by treating the cause. Kuhle S, Kirk SFL, Ohinmaa A, Urschitz MS, Veugelers PJ. In particular, the disinhibitory model we describe requires rigorous assessment of individual differences in oral anatomy and sensation to identify healthy function vs. patterns of regional dysfunction. The causes of olfactory dysfunction that are most amenable to treatment include obstructing polyps or other masses (treated by excision) and inflammation (treated with steroids). Rev Endocr Metab Disord. Stimuli are presented on the right and left sides at each site, and subjects make quality and intensity judgments using magnitude matching or a global intensity scale. Nelson HM, Daly KA, Davey CS, Himes JH, Snyder DJ, Bartoshuk LM. Morgan DH, Goode RL, Christiansen RL, Tiner LW. Coldwell SE, Mennella JA, Duffy VB, Pelchat M, Griffith JW, Smutzer G, et al. Other observations indicate that glossopharyngeal nerve loss drives CT disinhibition in a similar manner [50], and that damage to either nerve leads to elevated somatosensory input from the trigeminal nerve [e.g., 51]. Imai H, Soeda H, Komine K, Otsuka K, Shibata H. BMC Palliat Care. Trigeminal sensory system. The chorda tympani (CT), a branch of the facial nerve (cranial nerve VII), carries taste information from fungiform papillae, while the lingual branch of the trigeminal nerve (cranial nerve V) carries pain, tactile, and temperature information from fungiform and filiform papillae in the same region [2, 3]. An open-label, dose escalation pilot study of the effect of clonazepam in burning mouth syndrome. Sweetness: History, preference, and genetic variability. Morphological and functional study of regenerated chorda tympani nerves in humans. Tomofuji S, Sakagami M, Kushida K, Terada T, Mori H, Kakibuchi M. Taste disturbance after tonsillectomy and laryngomicrosurgery. Ott I, Tebben H, Losenhausen H, Issing PR. Felix F, Tomita S, de Bragana Pereira B, Cordeiro JR, Carleti G, de Souza Barros F, et al. Nasri C, Teixeira MJ, Okada M, Pormigoni G, Heir G, de Siqueira JTT. 8600 Rockville Pike Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics. Psychophysical assessment of tactile, pain, and thermal sensory functions in burning mouth syndrome. See permissionsforcopyrightquestions and/or permission requests. Rev Endocr Metab Disord. Peripheral neuropathy occurs in the nerves of your arms and hands or legs and feet. Healthcare providers use VNS to send electrical signals to your brain. Fortanier AC, Venekamp RP, Boonacker CWB, Hak E, Schilder AGM, Sanders EAM, et al. Individual differences in oral sensation, based on oral anatomy and genetics, present a challenge in distinguishing normal vs. abnormal function. El-Deiry A, McCabe BF. Multimodal information (i.e., taste, tactile, pain, and thermal cues) is carried from circumvallate papillae by the glossopharyngeal nerve (cranial nerve IX), from palatal taste buds by the greater superficial petrosal nerve (GSP, another branch of VII), and from the throat by the superior laryngeal branch of the vagus (cranial nerve X) [4-7]. Zuniga JR, Chen N, Miller IJ. Would you like email updates of new search results? Of these cases, the ulnar nerve was most often injured. On the other hand, regional nerve loss goes unnoticed in many individuals because it does not always lead to whole-mouth sensory loss. excessive vagus nerve activity can cause loss of consciousness and organ damage. Transection of the CT in humans leads to taste bud degeneration and corresponding taste loss, but fungiform papillae remain intact because they are structurally supported by the trigeminal nerve [167, 168]. Illness or Infection Anything that irritates and inflames the inner lining of your nose and makes it feel stuffy, runny, itchy, or drippy can affect your senses of smell and taste. Unauthorized use of these marks is strictly prohibited. This includes the common cold, sinus infections, allergies, sneezing, congestion, the flu, and COVID-19. Relationships between neuronal morphology and physiology. Still, in these and other cases of CT damage, follow-up taste testing often reveals persistent change and incomplete recovery of function [e.g., 36, 40, 41]. Frank ME, Smith DV. Tepper BJ, Nurse RJ. Research centers often use four ready-made solutions containing sucrose (sweet), sodium chloride (salty), quinine (bitter) and citric acid (sour) to obtain information about taste discrimination. Journal of Oral and Maxillofacial Surgery. When structural or inflammatory causes of smell or taste loss are suspected, imaging studies may be helpful in selected patients.18,23,28,29 However, all imaging techniques have limitations, and negative tests cannot rule out structural lesions. In: Doty RL, editor. Toxic neuropathy is nerve damage caused by toxic (harmful) substances. Topical application of capsaicin for treatment of oral neuropathic pain and trigeminal neuralgia. A complete loss of smell ( anosmia) or loss of taste ( ageusia) is rare. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Landis BN, Beutner D, Frasnelli J, Httenbrink KB, Hummel T. Gustatory function in chronic inflammatory middle ear diseases. Unable to load your collection due to an error, Unable to load your delegates due to an error. Unplanned weight loss. Oral sensory pathology moderates the relationship between fungiform papilla density and taste intensity. The senses of smell and taste allow full appreciation of the flavor and palatability of foods and also serve as an early warning system against toxins, polluted air, smoke and spoiled food products.1 Physiologically, the chemical senses aid in normal digestion by triggering gastrointestinal secretions.2. Dry mouth is often due to the side effect of certain medications or aging issues or as a result of radiation therapy for cancer. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Todrank J, Bartoshuk LM. Exploring associations between taste perception, oral anatomy, and polymorphisms in the carbonic anhydrase (gustin) gene CA6. It is also the preferred technique for evaluating the skull base for invasion by sinonasal tumors. Bulbar gustatory responses to anterior and to posterior tongue stimulation in the rat. Brazilian Journal of Otorhinolaryngology. National Health and Nutrition Examination Survey (NHANES) Taste and Smell Examination Component Manual. Burning mouth complaints: Clinical characteristics of a Brazilian sample. . In cases involving CT trauma sustained during otologic surgery, advances in technique have eased the recovery process: Oral sequelae are less frequent when the CT is stretched rather than cut [31-37] and recovery rates following transection are highest when the cut ends are reattached [38, 39]. Based on several clinical studies, patients with idiopathic BMS tend to be supertasters with bitter taste loss and trigeminal hyperalgesia on the anterior tongue, consistent with CT loss [83-87]. Stevens JC, Marks LE. Fox AL. 1999 Jan;109(1):123-8. doi: 10.1097/00005537-199901000-00024. Oral sensation shows broad individual differences under healthy conditions, so it can be difficult to distinguish sensory outcomes of nerve damage from normal sensation, particularly at low levels (which occur, for example, in both healthy nontasters and in supertasters with severe loss). This work was supported by the National Institute on Deafness and Other Communication Disorders (R01 DC00283; R21 DC013751). Taste receptors are found within taste buds located not only on the tongue but also on the soft palate, pharynx, larynx, epiglottis, uvula and first one third of the esophagus.2022 Taste buds are continually bathed in secretions from the salivary glands, and excessive dryness can distort taste perception. Head trauma, taste damage, and weight gain. Clinical laboratory tests may be helpful in ruling out coexisting medical conditions suggested by the history and physical examination, such as infection, nutritional deficiency, allergy, diabetes mellitus and thyroid, liver or kidney disease (Table 4). Likert R. A technique for the measurement of attitudes. The cell bodies of the facial nerve associated with taste occur within the geniculate ganglion. Tie K, Fast K, Kveton JF, Cohen ZD, Duffy VB, Green BG, et al. Brachial neuritis . Taste. Referral centers specialize in detailed quantitative testing of smell and taste function. The CT and the lingual branch of V exit the tongue together in a common sheath and proceed through the pterygomandibular space before separating. Woda A, Navez ML, Picard P, Gremeau C, Pechard-Leandri E. A possible therapeutic solution for stomatodynia (burning mouth syndrome). Many common conditions can affect your ability. Is phantom tooth pain a deafferentation (neuropathic) syndrome? Similarly, oral sensory phantoms can vary in quality (including taste, oral touch, and pain), location in the mouth, and perceived intensity. Olfactory disturbance has many possible causes (Table 1).1,68,15,16 In most instances, loss of smell is caused by nasal and sinus disease, upper respiratory tract infection or head trauma. Smell and taste disorders: A study of 750 patients from the University of Pennsylvania Smell and Taste Center. In addition to the painful shingles rash, Ramsay Hunt syndrome can cause facial paralysis and hearing loss in the affected ear. 2011;10:Doc04. Supporting this view, unilateral CT anesthesia augments contralateral oral burn only in supertasters [51], and it fails to produce taste constancy in nontasters [71]. Epub 2012 Apr 26. The severity of peripheral nerve injury can be classified as neurapraxia, axonotmesis, or neurotmesis according to 1942 Seddon's classification,[1][2] or the five different degrees according to the 1951 Sunderland's classification. Please enable it to take advantage of the complete set of features! Copyright 2023 American Academy of Family Physicians. Journal of the American Dietetic Assocation. Hillerup S, Jensen R. Nerve injury caused by mandibular block analgesia. However, oral disinhibition cannot sustain these sensations when multiple nerve fields are compromised (i.e., CT + IX), so whole-mouth sensation falls [e.g., 47, 49]. In: Bailey BJ, editor. In: Meiselman HL, Rivlin RS, editors. Some cases of nerve damage . [Evaluating function and disorders of taste]. Taste dysfunction may affect any taste quality, so electrogustometry may miss relevant deficits. Ramsay Hunt syndrome is caused by the same virus that causes chickenpox. MeSH Grushka M, Sessle BJ. Careers, Unable to load your collection due to an error. Surgical resection of vestibular and auditory system tumors (e.g., acoustic neuroma) can compromise the nervus intermedius. Bartoshuk LM, Duffy VB, Chapo AK, Fast K, Yiee JH, Hoffman HJ, et al. Terada T, Sone M, Tsuji K, Mishiro Y, Sakagami M. Taste function in elderly patients with unilateral middle ear disease. Qualitative odor sensations (e.g., the smell of a rose, lemon or grass) are mediated by cranial nerve I (Figures 2a and 2b), whereas somatosensory overtones of odorants (e.g., warmth, coolness, sharpness and irritation) are mediated by the ophthalmic and maxillary divisions of cranial nerve V. Smell receptors are located within the olfactory neuroepithelium, a region of tissue found over the cribiform plate, the superior septum and a segment of the superior turbinate. Vellappally S. Burning mouth syndrome: A review of the etiopathologic factors and management. International Journal of Oral and Maxillofacial Surgery. The .gov means its official. Oral disinhiibtion varies with taster status: Unilateral anterior oral anesthesia produces asymmetric posterior taste loss in nontasters. 2004 Dec;37(6):1127-42. doi: 10.1016/j.otc.2004.06.010. Waite PME, Ashwell KWS. Phantom oral sensations, which occur in the absence of obvious stimulation, are another consequence of oral disinhibition. Arnold SM. Folmer RL, Griest SE, Martin WH. Zuniga JR, Davis SH, Englehardt RA, Miller IJ, Schiffman SS, Phillips C. Taste performance on the anterior tongue varies with fungiform taste bud density. Meanwhile, a case report describes a bitter phantom that arose bilaterally at IX following tonsillectomy. Elsewhere, damage to the chorda tympani is a potential side effect of dental anesthesia, third-molar removal, laryngoscopy, and intubation procedures. Gairns FW. Several things can trigger a loss of taste. Aging in the 1980s: Psychological Issues. official website and that any information you provide is encrypted McCaig LF, Hughes JM. Non-supertasters (also known as medium tasters and nontasters) express fewer fungiform papillae and perceive less intense taste sensations [63, 64]. Some observations of the innervation of the human nasopharynx. Gustation assessment using the NIH Toolbox. Over time, high blood sugar can affect your blood flow and cause nerve damage that makes it hard for your body to heal wounds. Notably, taste-related nerve damage may carry especially robust and long-lasting consequences for bitterness, as the nerve fibers conveying it are small, unmyelinated, and susceptible to environmental insult [43-45]. Several afferent nerves carry sensory information from the mouth, each carrying a specific array of information from a specific area. The site is secure. People with this condition describe all foods as tasting sweet, sour, bitter or metallic. Do polymorphisms in chemosensory genes matter for human ingestive behavior? In: Doty RL, editor. Bell's palsy) or polyneuropathy, epilepsy, dementia, multiple sclerosis and major depression. 8600 Rockville Pike The influence of head trauma, otitis media, and tonsillectomy on oral sensation, fat acceptance, and body mass index (BMI). Erdogmus S, Govsa F, Celik S. Anatomic position of the lingual nerve in the mandibular third molar region as potential risk factors for nerve palsy. Tepper BJ, Ullrich NV. Mueller C, Kallert S, Renner B, Stiassny K, Temmel AF, Hummel T, et al. Oral sensory nerve damage has complex effects on whole-mouth sensation and food behavior that have resisted easy clinical interpretation for over a century, but we believe that better understanding has already arisen from careful chemosensory measurement of a broader nature than previous efforts have explored. Peripheral neuropathy therefore is used to describe any situation involving damaged or disrupted nerves . McBurney DH. Other surgical risks to IX include sleep apnea treatment and skull base surgery [22, 23], and posterior taste loss in the elderly suggests further nerve weaknesses that are not fully understood [24]. As an alternative to these fixed scales, measurement theorists developed the method of magnitude estimation, in which individuals freely assign numbers to sensations in ratios corresponding to their perceived intensity; by definition, 8 is twice as strong as 4 [e.g., 139]. Chemosensory function during healthy aging, Alzheimer's, and Parkinson's disease. Careers. In particular, more detailed images are needed when endoscopic surgery is to be performed. Neurotmesis is a complete transection of a peripheral nerve. Formaker BK, Mott AE, Frank ME. Box 110370, Gainesville, FL 32611-0370, USA, The publisher's final edited version of this article is available at, Taste, oral sensation, otitis media, tonsillectomy, phantom taste, burning mouth syndrome, obesity, intensity scale. However, some investigators have suggested that topical steroids do not reliably restore smell function.30 A useful dosing regimen for oral prednisone is 60 mg per day for four days, with the dosage tapered by 10 mg each day thereafter.30, Medical treatments generally are not effective in restoring olfactory function in patients with smell dysfunction after an upper respiratory infection.7,31 However, some investigators have suggested that absence of smell function (anosmia) subsequent to an upper respiratory infection may improve over time without specific treatment.32, In general, the olfactory system regenerates poorly after a head injury.7,17,19 Most patients who recover smell function subsequent to head trauma do so within 12 weeks of injury.17, Cigarette smoking by itself does not cause complete loss of the sense of smell. These tools include refined psychophysical scaling, visualization of oral anatomy, and spatial oral sensory testing. Electrogustometry, the application of mild electric current to the oral surface, may be the best-known method for localized stimulation of the mouth [e.g., 150-152], but it has two key limitations. 2016 Jun;17(2):149-58. doi . and transmitted securely. Catalanotto FA, Broe ET, Bartoshuk LM, Mayo VD, Snyder DJ. Another mechanism of taste loss is damage to one or more of the neural pathways innervating the taste buds (e.g., subsequent to viral Bell's palsy or dental or surgical procedures). Learn more about the causes, diagnosis, and treatment. Shibahara T, Eizou T, Katakura A. Consequently, treatment and management options remain sparse. In recent years, oral pain phantoms have also been linked to regional oral sensory nerve damage [75-79]. Neurophysiological methods such as blink reflex and masseter reflex allow the testing of trigeminofacial and trigeminotrigeminal pathways. These include: . Sometimes it lingers even after the infection has passed. Nevertheless, we remain confident that advances in oral sensory assessment will yield improved health outcomes, as they yield highly predictive and highly comparable profiles of flavor-related experience in health and disease. Zahm DS, Munger BL. Chilla R, Brner M, Arglebe C. Function of submaxillary gland following iatrogenic damage to chorda tympani nerve. Its central processes enter the brainstem at the pontomedullary junction and travel caudally to the medulla oblongata, where they synapse at the nucleus solitarius. Federal government websites often end in .gov or .mil. Yanagisawa K, Bartoshuk LM, Catalanotto FA, Karrer TA, Kveton JF. Patients should be cautioned not to overindulge as compensation for the bland taste of food. Although these disorders can have a substantial impact on quality of life and may represent significant underlying disease, they are often overlooked by the medical community. Michael P, Raut V. Chorda tympani injury: Operative findings and postoperative symptoms. Videomicroscopy of the tongue has also enabled identification of some forms of oral sensory pathology. Journal of the Canadian Dental Association. Cranio: The Journal of Craniomandibular Practice. Flavor perception plays an essential role in food choice, which in turn guides long-term nutritional outcomes [e.g., 101]. Bromley SM, Doty RL. The development of sweet taste: From biology to hedonics. International Common Otology Database: Taste disturbance after stapes surgery. Age-related deficits in the ability to smell are well documented,13,14 and such deficits appear in the majority of elderly patients who are healthy and taking no medications.14 However, the complaint of smell loss should never be attributed just to age, and other causes should be sought. Marbach JJ. Long-term follow-up results of electrogustometry and subjective taste disorder after middle ear surgery. Certain conditions, like olfactory neuroblastoma, can cause olfactory nerve damage, resulting in multiple symptoms. Mucous membranes should be evaluated for dryness, leukoplakia and exudate. Clinical Otolaryngology and Allied Sciences. Bethesda, MD 20894, Web Policies Overall, the diversity and unpredictability of these outcomes have vexed clinical efforts for over a century, confounding a definitive model of oral sensory dysfunction [e.g., 25-27] and public health estimates of its prevalence [28, 29]. Bartoshuk LM, Fast K, Snyder DJ. What causes smell disorders? An artificial saliva (e.g., Xerolube) may be helpful in patients with xerostomia. 1, 6 - 8, 15, 16 In most instances, loss of smell is caused by nasal and sinus disease, upper respiratory. Otitis media influences body mass index by interacting with sex, age and taste perception. Before Put another way, if 8 means searing pain to one person and a light tingle to another, then the distinction between 8 and 4 has little useful meaning. For example, marinating chicken in chicken-flavored bouillon may increase the palatability of the meat. Bitter taste of saccharin: Related to the genetic ability to taste the bitter substance 6-. It is a form of peripheral neuropathy, damage to the nerves away from the brain and spinal cord. National Library of Medicine In some cases, there may be no known cause of nerve damage. Alteration of taste can occur because of the release of bad-tasting materials as a result of an oral medical condition (e.g., gingivitis, sialadenitis). and transmitted securely. The effects of topical anesthesia on oral burning in burning mouth syndrome. The free nerve endings of cranial nerve V are located diffusely throughout the nasal respiratory epithelium, including regions of the olfactory neuroepithelium. Oral Surgery, Oral Medicine, Oral Pathology. Chilla R, Nicklatsch J, Arglebe C. Late sequelae of iatrogenic damage to chorda tympani nerve. Kanagasuntheram R, Wong WC, Chan HK. Journal of the American Medical Association. MRI is superior to CT scanning in the evaluation of soft tissues, but it poorly defines bony structures. Urine output. HHS Vulnerability Disclosure, Help An example of a scale with ratio properties is the visual analogue scale (VAS), a line labeled at its endpoints with the minimum and maximum intensities of a given attribute (e.g., not at all vs. extremely liked) [137, 138]. Lloyd S, Meerton L, Di Cuffa R, Lavy J, Graham J. The site is secure. Rice JC. Hausser-Hauw C, Bancaud J. Gustatory hallucinations in epileptic seizures. Current Directions in Psychological Science. For example, one might ask, This candy tastes very sweet to me; does it taste very sweet to you? but the answer is merely a rough estimate because neither party knows how intense very sweet actually is to the other person. Accordingly, we treat fungiform papilla density as a stable index of innate, pre-existing oral sensory capacity, and we interpret sensory deviations from it (e.g., high density + low sensation) as the effect of nerve damage [e.g., 169]. Other possible causes of nerve damage include: repetitive motion, Lyme disease, sudden trauma, aging, vitamin deficiencies, exposure to toxins, infections, and autoimmune disorders. Ohtsuka K, Tomita H, Murakami G. Anatomy of the tonsillar bed: Topographical relationship between the palatine tonsil and the lingual branch of the glossopharyngeal nerve. Hayes JE, Feeney EL, Allen AL. Bartoshuk LM, Catalanotto FA, Hoffman HJ, Logan H, Snyder DJ. Duffy VB. Scaling methods allowing valid group comparisons have strongly aided these efforts. To complicate matters, another important source of oral sensory variation is damage to the nerves carrying it. Uygur K, Bayramoglu I, Nazikolu A, Yilmaz M, Bayazit Y, Muftuoglu S. Ultrastructural analysis of the chorda tympani nerve in chronic suppurative otitis media. Specific questions should be asked about dryness of the mouth, periodontal disease, foul breath odor, recent dental procedures, recent radiation exposure, gastric reflux and medication use. Individual differences in the capacity to perceive oral sensation may also contribute to the impact of oral sensory loss. Trauma can cause loss of olfactory detection, such as damage to the olfactory nerve from cribriform plate fractures or closed head injury (from nerve disruption or shearing forces), or .

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